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NPI Code Detail

MEDICARE: KIMBERLY MOLDENHAUER NP

MEDICARE: KIMBERLY MOLDENHAUER NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner143118WI

General Provider Information

NPI Number : 1720420391
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY MOLDENHAUER NP
Provider Business Mailing Address
First Line : 23 W SCOTT ST
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-2342
Country : US
Telephone Number : 920-926-0101
Fax Number :
Provider Business Practice Location Address
First Line : 23 W SCOTT ST
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-2342
Country : US
Telephone Number : 920-926-0101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2013
Last Update Date : 06/07/2023

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Directions to “ KIMBERLY MOLDENHAUER NP” Practice Location

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